Chapter 13: Drug therapy in Older Adults

Question 1

Considerations for older clients

Answer 1

• altered pharmacokinetics (more sensitive to drugs with greater variation)
• multiple and severe illnesses
• multiple drug therapy
• poor adherence

Question 2

does the percentage of oral dose that is absorbed change with age

Answer 2

no

Question 3

the rate of absorption may ______ with age

Answer 3

slow
- delayed gastric emptying and reduced blood flow to the stomach

Question 4

how is Distribution effected in older adults

Answer 4

• increased percentage of body fat
• decreased percentage of lean body mass
• decreased total body water
• reduced concentration of serum albumin

Question 5

how does fat effect distribution of a drug

Answer 5

storage for lipid soluable drugs

Question 6

how does decreased total body water effect distribution

Answer 6

distributed in smallers volumes
- concentration increased and effects more intense

Question 7

how does reduced concentration of serum albumin effect distribution

Answer 7

causes decreased protein binding of drugs and increased levels of free drugs

Question 8

Hepatic metabolism _______ with age

Answer 8

declines

Question 9

how are the half lives effected in older adults

Answer 9

half lives of some drugs may increase, and responses are prolonged

Question 10

what is most important in older adults in regards to excretion

Answer 10

drug accumulation
- result of reduced renal excretion
- cause of most adverse drug reactions in older adults

Question 11

what is the cause of most adverse drug reactions in older adults

Answer 11

drug accumulation
- result of lower excretion

Question 12

creatine

Question 13

alterations in ________ may underlie altered sensativity to some drugs

Answer 13

receptor properties

Question 14

drugs with more intense effects in older adults

Answer 14

• warfarin
• central nervous system depressants

Question 15

why are beta blockers less effective in older adults

Answer 15

• reduction in the number of beta receptors
• reduction in the affinity of beta receptors

Question 16

adverse drug reactions are ___ more times likely in the elderly

Answer 16

7

Question 17

adverse drug reactions account for __% of hospital admissions

Answer 17

16

Question 18

adverse drug reactions in older adults are often

Answer 18

nonspecific
- dizziness, cognitive impairment

Question 19

predisposing ADR factors

Answer 19

• drug accumulation secondary to reduced reanl function
• polypharmacy
• greater severity of illness
• multiple pathologies
• greater use fo drugs that have low therapeutic index
• increased individual variations secondary to altered pharmacokinetics
• inadequate supervisions of long term therapy
• poor adherence

Question 20

Measures to reduce ADRs

Answer 20

• obtain a thorough drug history
• consider pharmacokineetic and pharmacodynamic changes due to age
• monitor the patietns clinical responses and drug plasma levels
• use the simplest regimen possible
• monitor for drug-drug reactions
• periodically review the need for continued drug therapy
• encourage the patients to dispose of old medications
• takes steps to promote adherence and to avoid drugs on the Beers list

Question 21

Promoting Adherence with Unintentional Nonadherence

Answer 21

• simplified drug regimens
• clear and concise verbal and written instruction
• appropriate dosage form
• clearly labeled and easy to open containers
• daily reminders
  -support system
• frequent monitoring

Question 22

__% of nonadherence are intentional

Answer 22

75

Question 23

intentional nonadherence reasons include

Answer 23

high cost or drugs, side effects, the patietns beleif that the drug is unnecessart or that the dosage is too high